on 21/03/2013 I had a protected sexual contact with a CSW in India. During foreplay I noticed she was lactating and copious amount of breast milk was coming out, which I used to wipe off with my hands. I had painful skin breaks around the nails on the thumb of both hands. Does his pose a risk for hiv transmission?

I had put on a condom and she first gave me a oral with the condom on.

Later on I penetrated her and while changing position when I pulled my penis out, I saw menstrual blood on the condom. The lady immediately removed the condom. Though I did not check, I feel the condom was not broken as I could not see any visual blood on my penis.

She then put on another condom on my penis and proceeded to give me oral. Here I am not sure whether she had got blood on her fingers when she removed the earlier condom.

Does this pose a risk, considering she had certain traces of blood on her fingers?

What is more worrying for me is she had earlier during a conversation agreed for a penetration without a condom, which means she would have also had unprotected sex with other clients.

Though I have been having intense itching from the 40th day onwards from the 42the day after the sexual incident, I have rash appear all over my neck and check.. The rash covers the front and both sides of my neck coming down to the chest. The rash is reddish with very tiny bumps.

Am very worried because in the last 40 days I have had unprotected sex with my wife

Also during foreplay I had inserted my finger into her vagina and there was vaginal fluid on my fingers. Do not know whether those fluids came in contact with my penis while putting on condom.

The imortant thing is that the vaginal sex was protected with a condom. Blood on the outside of a condom is no more risky than vaginal fluids on a condom; and menstrual blood probably carries no more risk for HIV than vaginal fluids do. Hand contact with breast milk or genital fluids is risk free, even with minor cuts and nicks on the hands. So all things considered, this was an entirely safe sexuIal experience with no appreciable risk of HIV transmission.

For those resons, you can safely assume your skin rash is not due to a new HIV infection. Equally important, it came on much too late -- an ARS rash would 10-20 days after exposure, not 6 weeks later; and would always be accompanied by fever and other symptoms. Finally, the rash itself (itching, the location) is not typical.

This rash sounds pretty unconfortable and something that should receive professional medical attention to judge the cause and perhaps get treated. But you need not worry at all about HIV or any other STD. Whatever the cause of your rash, I'm sure it has nothing at all to do with your sexual encounter a few weeks earlier.

Finally, you ask "Do I have to get tested for HIV?" From a medical or risk assessment standpoint, no. However, you might decide to be tested anyway, for reassurance. The negative test result probably will be more reassuring than anything I can say. (This does not mean I really believe you may be infected. I do not.)

If it's a test developed and used primarily in India, I cannot judge its performance, although I might be able to comment if you can provide the specific trade name, if it's one used in the US or western Europe. However, India has a sophisticated biotechnology industry, so most likely even an Indian test would be valid; and if it is a blood test (not oral fluids), it should be nearly 100% reliable at 45 days.

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